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Bormann NL, Miskle B, Holdefer P, Arndt S, Lynch AC, Weber AN. Evidence of telescoping in females across two decades of US treatment admissions for injection drug use: 2000-2020. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100204. [PMID: 38045494 PMCID: PMC10690569 DOI: 10.1016/j.dadr.2023.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023]
Abstract
Background People who inject drugs (PWID) have an increased risk of soft tissue infection, drug overdose and death. Females may be particularly vulnerable due to barriers to substance use disorder (SUD) treatment entry, stigma, and telescoping, or the greater severity in substance use-related comorbidity and consequences despite a shorter history of use. We set out to identify sex differences in United States injection drug use (IDU). Methods The Treatment Episode Dataset-Admission (2000-2020) provided data to identify PWID undergoing their initial SUD treatment admission. Mann-Whitney U test, chi-square, and Spearman correlations were used for ordinal variables, categorical variables, and to assess similarity of male/female trends over the 21 years, respectively. The probabilistic index (PI) and Cramer's V provided effect sizes for Mann-Whitney U tests and chi-square tests, respectively. Results A total of 13,612,978 records existed for cases entering their initial treatment. Mapping to a history of IDU left 1,458,695 (561,793 females). Females had a higher prevalence among PWID across all 21 years; IDU trends were essentially identical between males and females (r = 0.97). Females endorsed beginning their primary substance later in life (PI = 0.47, p < 0.0001) and entered treatment after a shorter period of substance use (PI = 0.57, p < 0.0001). Conclusions We saw evidence of telescoping among PWID with a SUD entering their initial episode of treatment. Interventions should be implemented prior to the transition to IDU, and this window of opportunity is shortened in females. Utilizing gender-responsive treatment options may be a way to increase treatment-seeking earlier in the disease course.
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Affiliation(s)
- Nicholas L. Bormann
- Department of Psychiatry and Psychology, Mayo Clinic, 404 W Fountain St, Albert Lea, Rochester, MN 56007, USA
| | - Benjamin Miskle
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Paul Holdefer
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Alison C. Lynch
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrea N. Weber
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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Razaghi E, Farhoudian A, Pilevari A, Noroozi A, Hooshyari Z, Radfar R, Malekinejad M. Identification of the socio-cultural barriers of drug addiction treatment in Iran. Heliyon 2023; 9:e15566. [PMID: 37131427 PMCID: PMC10149210 DOI: 10.1016/j.heliyon.2023.e15566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
Introduction Socio-cultural norms can either be encouraging or a barrier to addiction treatment. More, rigorous research is needed on nonindigenous models in addiction treatment, to better understand the role of socio-cultural differences. Methods The present qualitative study is part of the project, "The Inclusive Assessment of the Barriers of Drug Addiction Treatment Services in Iran," which was conducted in Tehran from 2018 to 2021. The participants consisted of eight people who used drugs, seven individual family members of the people who used drugs participants, seven service providers, and four policymakers. A purposeful sampling method was used for the selection of the participants, and the process continued until reaching the theoretical saturation of data. Analysis used the Graneheim and Lundman methods, classifying primary codes, the sub-themes, and themes were classified according to the similarities and differences between primary codes. Finding The most important socio-cultural barriers to addiction treatment in Iran are: unrealistic expectations of the family and society from the people who use drugs, addiction stigma, mistrust between various components of the treatment system, perceptions that professional substance use disorder treatment is inefficient and low uptake of that treatment, the disturbed relational boundaries between the people who use drugs and their relatives, the interweaving of treatment and ethical and religious principles, low acceptance of maintenance treatments, treatment focusing on short-term outcomes, and presence of facilitating backgrounds of using drugs. Conclusions The Iranian socio-cultural characteristics play an important role in the addiction treatment of the people who use drugs, so it is necessary for treatment interventions to be sensitive to these characteristics.
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Affiliation(s)
- Emran Razaghi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Pilevari
- Department of Sociology, Kharazmi University, Karaj, Iran
- Corresponding author.
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Science, Tehran, Iran
| | - Zahra Hooshyari
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Radfar
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Malekinejad
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, USA
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Elms N, Link K, Newman A, Brogly SB. Need for women-centered treatment for substance use disorders: results from focus group discussions. Harm Reduct J 2018; 15:40. [PMID: 30081905 PMCID: PMC6080513 DOI: 10.1186/s12954-018-0247-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/30/2018] [Indexed: 12/04/2022] Open
Abstract
Background There are few women-centered treatment programs for substance use disorder. We therefore undertook an exploratory study to better understand the treatment experience, barriers, and facilitators of mothers with substance use disorder. Methods We conducted two focus groups with a total of ten women with a history of substance use disorder in Kingston (Canada). Women were recruited from a community program for mothers with substance use disorder. The focus groups were recorded, and the resulting data were transcribed, coded, and thematically analyzed. Barriers, facilitators and treatment needs were identified. Results The mean age of the participants was 31.1 years, 30% were currently using substances, and 60% had a child in their care. A key concern for women regarding substance use treatment was the welfare of their child(ren). Agencies charged with child protection were a barrier to treatment because women feared disclosing substance use would result in loss of child custody. In contrast, when agencies stipulated that women must attend treatment to retain custody, they facilitated treatment engagement. Other barriers to treatment included identifying treatment programs and completing admission requirements, wait times, counselor ability to address woman-centered issues, fear, safety, and stigma. Women’s personal motivation for treatment was a facilitator. Suggestions to improve treatment programs included to allow children to accompany their mothers, involvement of peer support, and women-only programs. Conclusions This small but novel study provides important data to inform treatment programming for mothers with substance use disorders.
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Affiliation(s)
- Natasha Elms
- Department of Public Health Sciences, Queen's University, Carruthers Hall, 62 Fifth Field Company Lane, Kingston, Ontario, K7L 3N6, Canada
| | - Kendra Link
- Independent Researcher, 1746 Marian Crescent, Kingston, Ontario, K7L 5H6, Canada
| | - Adam Newman
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, Ontario, K7L 3G2, Canada
| | - Susan B Brogly
- Department of Surgery, Kingston Health Science Centre, Queen's University, Victory 3, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada.
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Doty-Sweetnam K, Morrissette P. Alcohol abuse recovery through the lens of Manitoban First Nations and Aboriginal women: A qualitative study. J Ethn Subst Abuse 2016; 17:237-254. [DOI: 10.1080/15332640.2016.1138268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Special Services for Women in Substance Use Disorders Treatment: How Does the Department of Veterans Affairs Compare with Other Providers? Womens Health Issues 2015; 25:666-72. [PMID: 26329259 DOI: 10.1016/j.whi.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/21/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gender is an important consideration in the treatment of substance use disorders (SUD). Although the number of women seeking care through the Department of Veterans Affairs (VA) has increased dramatically, little is known about the capacity of the VA to meet the needs of women with SUD. We examined the prevalence of programs and key services for women in VA facilities in a survey of 14,311 SUD treatment facilities. METHODS Using data from the 2012 National Survey of Substance Abuse Treatment Services, we calculated the percent of VA facilities offering special programs or groups exclusively for women, compared with facilities under other types of ownership. For each ownership type, we also calculated the mean number of ancillary services offered that are critical for many women in SUD treatment, including child care, domestic violence counseling, and transportation assistance. Multivariable models were used to adjust for differences in other facility characteristics. FINDINGS Approximately 31% of facilities had special programs exclusively for women. The VA had the lowest prevalence of programs for women, at 19.1%; however, the VA offered an average of 5 key services for women, which was significantly higher than the averages for other federal (n = 2), local (n = 4), and private for-profit (n = 2) facilities. Results were generally robust to multivariable adjustments. CONCLUSIONS The VA should consider developing more SUD programs and groups exclusively for women, while maintaining ancillary services at their relatively abundant level. Gender-specific programs and groups could serve as points of referral to ancillary services for women veterans.
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Greenfield SF, Cummings AM, Kuper LE, Wigderson SB, Koro-Ljungberg M. A qualitative analysis of women's experiences in single-gender versus mixed-gender substance abuse group therapy. Subst Use Misuse 2013; 48:750-60. [PMID: 23607675 PMCID: PMC3711015 DOI: 10.3109/10826084.2013.787100] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present study of women with substance use disorders used grounded theory to examine women's experiences in both the Women's Recovery Group (WRG) and a mixed-gender Group Drug Counseling (GDC). Semi-structured interviews were completed in 2005 by 28 women in a U.S. metropolitan area. Compared to GDC, women in WRG more frequently endorsed feeling safe, embracing all aspects of one's self, having their needs met, feeling intimacy, empathy, and honesty. In addition, group cohesion and support allowed women to focus on gender-relevant topics supporting their recovery. These advantages of single-gender group therapy can increase treatment satisfaction and improve treatment outcomes.
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Affiliation(s)
- Shelly F Greenfield
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, Massachusetts 02478, USA.
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Chuang E, Wells R, Alexander JA. Public managed care and service access in outpatient substance abuse treatment units. J Behav Health Serv Res 2012; 38:444-63. [PMID: 21184286 DOI: 10.1007/s11414-010-9230-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The continued growth of public managed behavioral health care has raised concerns about possible effects on services provided. This study uses a national sample of outpatient substance abuse treatment units surveyed in 2005 to examine associations between public managed care and service access, measured as both the types of services provided and the amount of treatment received by clients. The percentage of clients funded through public managed care versus other types of public funding was positively associated with treatment units' odds of providing some types of resource-intensive services and with the odds of providing transportation to clients, but was negatively associated with the average number of individual therapy sessions clients received over the course of treatment. In general, public managed care does not appear to restrict access to outpatient substance abuse treatment, although states should monitor these contracts to ensure clients receive adequate courses of individual treatment.
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Affiliation(s)
- Emmeline Chuang
- Department of Mental Health Law and Policy, Department of Child and Family Studies, College of Behavioral and Community Studies, 13301 Bruce B Downs Blvd, Tampa, FL 33612-3807, USA.
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Shin HC, Marsh JC, Cao D, Andrews CM. Client-Provider relationship in comprehensive substance abuse treatment: differences in residential and nonresidential settings. J Subst Abuse Treat 2011; 41:335-46. [PMID: 21871770 DOI: 10.1016/j.jsat.2011.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 03/22/2011] [Accepted: 03/29/2011] [Indexed: 10/17/2022]
Abstract
As the substance abuse service system shifts from primarily residential to primarily nonresidential settings, it becomes important to understand how substance abuse treatment processes and outcomes may vary across service setting. Research increasingly indicates that, along with specific treatment and service strategies, client-provider relationship is an important ingredient in effective substance abuse treatment. This study uses a moderator-mediator analysis of a comprehensive service model to examine how the relation between client-provider relationship and substance abuse treatment outcomes may differ in residential and nonresidential settings. The study used data collected for the National Treatment Improvement Evaluation Study, a prospective, cohort-based study of U.S. substance abuse treatment programs and their clients, with an analytic sample of 59 publicly funded service delivery units and 3,027 clients. Structural equation modeling is used to assess the structural relations and causal connections between treatment process and treatment outcome variables. Results indicate that for nonresidential settings, a better client-provider relationship is directly related to improved outcomes of treatment duration and reduced posttreatment substance use and is indirectly related to both outcomes through provision of services matched to client needs. In residential settings, the quality of the client-provider relationship is unrelated to process or outcome variables. The findings point to the importance of the client-provider relationship in all settings but particularly in outpatient settings where there are limited physical constraints on the treatment process.
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Affiliation(s)
- Hee-Choon Shin
- School of Social Service Administration, NORC at the University of Chicago, Chicago, IL 60637, USA
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Cao D, Marsh JC, Shin HC, Andrews CM. Improving health and social outcomes with targeted services in comprehensive substance abuse treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:250-8. [PMID: 21699362 DOI: 10.3109/00952990.2011.591016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Improved life functioning along with substance use reduction is increasingly recognized as the definition of effective addiction treatment. OBJECTIVES To assess whether targeted health and social services contribute to improved physical/mental health and employment. METHODS This study used data from the National Treatment Improvement Evaluation Study (N = 3027) and modeled the improvement in physical/mental health and employment at discharge or 12 months after discharge compared with intake measures as a function of receipts of matched services. RESULTS Receiving matched medical service improves physical health only at treatment discharge; receiving matched mental health services improves mental health at discharge and 12 months after discharge; receiving matched vocational services improves employment only 12 months after discharge. CONCLUSIONS Need-service matching contributes to improved health and social outcomes when longitudinal assessments of treatment outcomes are used to evaluate treatment effectiveness. SCIENTIFIC SIGNIFICANCE Study findings document the value of targeted services for achieving success in health and social functioning in comprehensive substance abuse treatment.
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Affiliation(s)
- Dingcai Cao
- Department of Surgery, Sections of Surgical Research and Ophthalmology & Visual Science, University of Chicago, IL, USA
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10
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Child care in outpatient substance abuse treatment facilities for women: findings from the 2008 National Survey of substance Abuse Treatment Services. J Behav Health Serv Res 2011; 38:478-87. [PMID: 21293975 DOI: 10.1007/s11414-011-9235-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mothers with substance use disorders who lack access to child care are often unable to enter or remain in substance abuse treatment. This study examined the availability of child care in outpatient substance abuse treatment facilities and whether or not certain facility characteristics were associated with the availability of child care. Using data from the 2008 National Survey of Substance Abuse Treatment Services, 6.5% of outpatient substance abuse treatment facilities that served women provided child care. The results of multivariate logistic regression found that child care was more common among facilities that were located in metropolitan areas, were operated by non-profit or government agencies, received public funding, or provided free services or other ancillary services including case management, domestic violence counseling, and transportation assistance. Facilities that served only women had more than three times higher odds of providing child care compared with mixed-gender facilities. Further research is needed to identify strategies for expanding child care in outpatient substance abuse treatment facilities.
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Marsh JC, Shin HC, Cao D. Gender differences in client-provider relationship as active ingredient in substance abuse treatment. EVALUATION AND PROGRAM PLANNING 2010; 33:81-90. [PMID: 19744712 PMCID: PMC2975429 DOI: 10.1016/j.evalprogplan.2009.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 07/23/2009] [Accepted: 07/28/2009] [Indexed: 05/17/2023]
Abstract
The client-provider relationship is increasingly evaluated as an active ingredient in the delivery of substance abuse treatment services. This study examines gender differences in client-provider relationship as an important treatment ingredient affecting retention in treatment and reduced post-treatment substance use. The study uses data collected for the National Treatment Improvement Evaluation Study (NTIES), a prospective, cohort study of U.S. substance abuse treatment programs and their clients. Data on individual characteristics were collected at the pre-treatment interview; on client-provider relationship and services received at treatment exit; and on post-treatment drug use at 12 months post-treatment. The analytic sample consists of 3027 clients from 59 service delivery units (1922 men and 1105 women). Structural equation modeling (SEM) was used to assess the structural relations and causal connections between relationship and service variables and treatment outcome variables. Results indicate that a positive client-provider relationship is related directly to longer duration and reduced post-treatment drug use for the total sample and for men analyzed separately. For women, a positive client-provider relationship was related directly to treatment duration and only indirectly to reduced post-treatment drug use. The findings point to the significance of including client-provider relationship in service delivery models--both as a therapeutic element as well as an element facilitative of matching services to specific client needs.
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Affiliation(s)
- Jeanne C Marsh
- School of Social Service Administration, University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA.
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Abstract
The National Institute of Drug Abuse has promoted drug abuse research in the past two decades focusing on women and gender differences. One hundred twenty-eight Hispanic and White women have participated in this comparative descriptive study that has examined the differences between chemically dependent (CD) women in recovery and non—chemically dependent (non-CD) women in regard to resilience and self-differentiation—demographic variables associated with resilience and self-differentiation and recovery variables associated with resilience and self-differentiation in the CD women. Findings indicate that the CD women and Hispanic women have scored significantly lower on measures of resilience and self-differentiation. Among the recovery variables, resilience and self-differentiation are significant for children support but community support is not significant. The finding that Hispanic and White women in recovery score lower on resilience and self-differentiation is important for designing treatment strategies supportive of women in recovery.
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Abstract
Treatment programs for women who use drugs during pregnancy have developed out of a backdrop of punitive policies and the psychosocial complexities of this population, which include psychological comorbidities and consideration of the needs of their children. In this literature review, we examine evidence-based approaches to treatment for these women and some promising newer initiatives. We also discuss limitations of this research and issues that need to be addressed. The increasing understanding and acceptance of substance abuse as a treatable mental health disorder brings renewed optimism to this field.
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Affiliation(s)
- Barry M Lester
- Warren Alpert Medical School of Brown University, Brown Center for the Study of Children at Risk, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA.
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Cheng AL, Kelly PJ. Impact of an integrated service system on client outcomes by gender in a national sample of a mentally ill homeless population. ACTA ACUST UNITED AC 2008; 5:395-404. [DOI: 10.1016/j.genm.2008.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2008] [Indexed: 11/26/2022]
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Organizational determinants of outpatient substance abuse treatment duration in women. J Subst Abuse Treat 2008; 37:64-72. [PMID: 19038526 DOI: 10.1016/j.jsat.2008.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 09/17/2008] [Accepted: 09/19/2008] [Indexed: 11/23/2022]
Abstract
Longer treatment duration has consistently been related to improved substance use outcomes. This study examined how tailored women's programming and organizational characteristics were related to duration in outpatient substance abuse treatment in women. Data were from two waves of a national outpatient substance abuse treatment unit survey (n = 571 in 1999/2000, n = 566 in 2005). Analyses were conducted separately for methadone and nonmethadone programs. Negative binomial regressions tested associations between organizational determinants, tailored programming, and women's treatment duration. Of the tailored programming services, childcare was significantly related to longer duration in the nonmethadone programs, but few other organizational factors were. Tailored programming was not associated to treatment duration in methadone programs, but ownership, affiliation, and accreditation were related to longer duration. Study findings suggest evidence for how external relationships related to resources, treatment constraints, and legitimacy may influence women's treatment duration. Methadone programs may be more vulnerable to external influences.
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Grella CE. From Generic to Gender-Responsive Treatment: Changes in Social Policies, Treatment Services, and Outcomes of Women in Substance Abuse Treatment. J Psychoactive Drugs 2008; Suppl 5:327-43. [DOI: 10.1080/02791072.2008.10400661] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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